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Book review

Human Body Size and the Laws of Scaling: Physiological, Performance, Growth, Longevity and Ecological Ramications,
T.T. Samaras (Ed.), Nova Science Publishers Inc., New York (2007).
Human body size and the laws of scaling is a collection of chapters, mostly by Samaras but with contributions from
Andrzej Bartke and C. David Rollo. Samaras is Director of Reventropy Associates in San Diego, and has published extensively
on the biological and health signicance of variability in growth and size.
This book is packed with ideas, and I challenge any reader working within the eld of human growth to read even one
chapter without achieving newinsights into their area of expertise. Having said that, less is made of the laws of scaling than
the title might suggest, and the central theme of the book concerns associations between between-individual variability in
childhood growth rate or adult size, and a range of biological and health outcomes.
Probing the signicance of within- andbetween-populationvariability insize for diverse biological outcomes is a much-
needed academic contribution, for several reasons. First, clinical research has long been dominated by imperfect
approaches to adjusting for body size, reected for example in persisting mainstream acceptance of body mass index
(weight divided by height squared) as the primary obesity index, even though its association with fatness in individuals is
imperfect, and confounded by stature (for example, abdominal obesity as indexed by waist girth is associated with reduced
height in men (Wells et al., 2007)). Many biological parameters such as metabolic rate are inappropriately adjusted for size
in clinical practice or research studies, leading to misinterpretations of their signicance. Second, bigger has widely been
regarded as better, more on the basis of human psychology than biomedical data. For example, babies gaining weight
rapidly appear to be thriving, taller children are regarded as healthier, and taller adults tend to come from higher social
status groups.
This book begins with a brief background as to why the study of human size is important, and then addresses the issue of
how a variety of physiological parameters (e.g. physical capabilities, bone and muscle strength) scale with, i.e. vary in
proportion to, height or weight. The level of detail provided in this approach is novel, with a key contribution comprising
elucidation of the diversity of relationships between size and different outcomes. Some variables increase in proportion to
height or weight, whereas others decrease, with a variety of underlying scaling associations. Put together, the implication is
that a large human differs in a number of ways from a small human, and the appropriate adjustment or interpretation
depends on the trait being investigated.
The following two chapters are complementary, exploring in turn the advantages of tall height versus short height. The
fact that both tall and short stature are benecial in certain circumstances implies trade-offs between competing functions,
however this issue is not addressed in detail. This reects a predominance of medical studies in the literature reviewed, with
less attention paid to broader human ecology and population diversity. Nevertheless, the reader is immediately aware that
neither extreme of height may be considered ideal, and that there are both behavioural and metabolic benets and costs in
either direction.
The following three chapters are effectively the core of the book, reviewing from different perspectives the hypothesis
that greater size/growth is associated with increased risk of many of the principal diseases encountered in industrialised
populations, and increasingly in developing country populations. Greater weight and height are increasingly linked with
diabetes, cardiovascular disease, cancer and obesity in diverse populations. Such studies are challenged by the difculty of
adjusting for confounding factors, many of which are only assessed at a single time point, but the ndings do show
consistency across populations. Samaras considers two hypotheses, size per se, and variability in growth that underlies size
variation. The contribution of growth variability in turn has implications for the differential impact of particular life-course
periods. Samaras conclusion is that faster growth imposes signicant metabolic costs, and two chapters contributed by
Bartke and Rollo provide a valuable supporting perspective based on studies of transgenic small or large mice. These chapters
show that small mice live longer and are relatively protected against conditions such as cancer or metabolic derangements,
whereas large mice have shorter life-spans and associated deleterious conditions.
The literature examined here is comprehensive (indeed in the introduction reference is made to the review of over 5000
scientic papers), and Samaras rigorously addresses evidence both for and against his two hypotheses. One issue of
particular importance, addressed here in detail, concerns differentiating on the one hand between factors that may impact
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adversely on both growthand health, and on the other hand costs of enhanced growthitself. I have no contention whatsoever
with what I take to be the key message from this book, namely that maximising growth can impose signicant health costs
such as increased cardiovascular risk on human phenotype, but some important questions remain.
In some sections, Samara suggests that short height itself appears protective against lifestyle diseases. Some of the
evidence here is extremely tangential, such as the proposition that cardiovascular disease is not recorded in some
populations (e.g. Kitava in the Trobriand Islands, African pygmies and Australian aborigines) which are also short. The
difculty here is that there are several possible underlying explanations for the lack of cardiovascular disease in non-
industrialised populations, and they invoke quite different biological mechanisms.
I would argue that there are in fact three plausible mechanisms linking growth/size with outcome. First, there is size per
se, as addressed here in chapters 3 and 4. Second, there is growth per se, as addressed in chapters 7, 8 and 10. However there
is a third scenario, which is not really addressed, and which concerns discordant growth patterns within the life-course or
betweengenerations. It is perhaps telling that minimal reference is made inthis booktothe thrifty phenotype hypothesis of
Hales and Barker (1992), which proposed that the small baby represents a strategy of prioritising short-term survival in
response to poor fetal nutrition, with long-termeffects on size and metabolism. This is surprising, because this perspective
has proved extremely valuable in interpreting biomedical studies on associations between early life growth and risk of
subsequent disease. Increasingly, evidence suggests that changes in growth rate between different growth periods
generate disparity betweenmetabolic capacity andmetabolic load(Wells, 2007; Barker et al., 2005). This canhappeneither
because childhood diet is at odds with pregnancy experience, or because one generation occupies an ecological
environment very different to that of the previous generation. Populations fromnon-industrial environments that happen
to be short may also have had relatively stable nutritional experience in recent generations, as well as having avoided
exposure to high-load diets. I happen to believe that growth discordance is fundamental to associations between growth
and disease (Wells, 2007), and at the very least this mechanism would have beneted from equal consideration to those
others included in this book.
For example, minimal attention is directed to long-term secular trends in human growth. An increasing volume of
evidence supports the notionthat height inEuropean populations underwent a long-termdecline following the emergence
of agriculture, followed by a period of inconsistent uctuations, followed by a secular increase once the industrial
revolution had consolidated (Komlos, 1998). Such trans-generational change appears an important means of
accommodating environmental uctuations, and might be considered broadly adaptive. It is plausible that the costs of
such change are modest providing its rate is constrained in any one generation, and that what we are seeing in the 20th and
21st centuries is acceleration inthe rate of niche construction, resulting inthe speeding up of secular trends in height to the
extent that the metabolic costs (manifesting as increased cardiovascular risk) are amplied substantially. Such a
hypothesis is supported by the fact that cardiovascular disease emerged in western populations along with the 20th
century secular trend in height.
On a related theme, the chapter on human evolutionary ecology was in my viewthe least successful of the book, raising a
number of important themes but failing to capitalise with valuable conclusions. An evolutionary perspective is essential for
comprehensive understanding of the costs and benets of growth variability, but although there has been substantial recent
progress of linking human life history theory to growth and maturation rates (e.g. Bogin, 1999; Hill and Kaplan, 1999), this
perspective was not explored productively.
The nal chapters address possible associations between growth and intelligence, and resource and economic
requirements. The latter is important in demonstrating that the implications of growth extend beyond specically metabolic
outcomes, while the former made the point that associations between brain size and intelligence are probably
inconsequential across the normal range of head size, compared to other factors.
To my knowledge, this book provides the most comprehensive examination to date of the hypothesis that human growth
may have costs as well as benets. Whilst I have highlighted some areas which I felt deserved greater emphasis or re-
examination, I thoroughly enjoyed reading the chapters, and was rewarded with a range of novel points, new perspectives
and the kind of facts that one continues mulling over for some time afterwards. Samaras has clearly mastered a phenomenal
volume of scientic literature, and the reader is greatly indebted for such effort and thoughtful interpretation. It takes a
certain generosity to provide extensive rawmaterial with such clarity that the reader has the opportunity to formulate his or
her own perspective, in addition to encountering the authors.
In many ways, this book is challenging conventional biomedical wisdom, which has long considered size a marker for
health, and growth a proxy for good nutrition and constrained disease load. The obesity epidemic has focused attention on
the adverse effects of high metabolic load (e.g. high blood pressure and insulin resistance) relating to large size, but less
interest has in general been directed to the process of growth itself. I strongly recommend the book to academics across a
wide range of disciplines and suspect that many will nd themselves challenging their long-held views about the association
between growth and health.
Barker, D.J., Osmond, C., et al., 2005. Trajectories of growth among children who have coronary events as adults. N. Engl. J. Med. 353, 18021809.
Bogin, B., 1999. Evolutionary perspective on human growth. Annu. Rev. Anthropol. 28, 109153.
Hales, C.N., Barker, D.J.P., 1992. Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia 35, 595601.
Hill, K., Kaplan, H., 1999. Life history traits in humans: theory and empirical studies. Ann. Rev. Anthropol. 28, 397430.
Book review 490
Komlos, J., 1998. Shrinking in a growing economy? The mystery of physical stature during the industrial revolution. J. Econ. Hist. 58, 779802.
Wells, J.C.K., 2007. The thrifty phenotype as an adaptive maternal effect. Biol. Rev. 82, 143172.
Wells, J.C.K., Treleaven, P., Cole, T.J., 2007. BMI compared with 3D body shape: the UK national sizing survey. Am. J. Clin. Nutr. 85, 419425.
Jonathan C.K. Wells*
Childhood Nutrition Research Centre, UCL Institute of Child Health,
30 Guilford Street,
London WC1N 1EH, United Kingdom
*Fax: +44 207 831 9903
E-mail address:
(J. C.K. Wells)
2 July 2008
Book review 491